Denial code guide

PR-227 Denial Code: Missing Patient Information

PR-227 means a payer did not receive complete information requested from the patient, insured, or responsible party. The fastest path to resolution starts with the accompanying remark code, not the 227 alone.

Prevent more denialsSee how to fix it

Quick answer

CARC 227 identifies missing or incomplete information requested from the patient side

PR is the patient-responsibility group code. Review the RARC and payer message to learn exactly what is missing before contacting the patient or changing the balance.

Remittance detailAction required
Group code
PR
Patient responsibility
Reason code
227
Missing information
Remark code
RARC
Read for specifics

Read the full code

What PR-227 means

PR-227 combines two parts of the remittance. PR is the Claim Adjustment Group Code for patient responsibility. 227 is the Claim Adjustment Reason Code indicating that information requested from the patient, insured, or responsible party was not provided or was insufficient or incomplete.

The accompanying Remittance Advice Remark Code, or RARC, is the operational key. It should tell your team what information the payer needs or what action remains unresolved. A 227 without the rest of the remittance context is not enough to determine the correction.

Common causes of PR-227

The exact cause varies by payer and remark code. Start with the RARC, payer correspondence, and claim notes.

Coordination of benefits
The patient has not answered a request about other active coverage or which plan should pay first.
Accident or liability details
The payer is waiting for information about an injury, auto accident, workplace event, or another responsible party.
Subscriber information
Patient, insured, or subscriber details are incomplete or do not match the payer's coverage record.
Forms or signatures
A patient questionnaire, authorization, attestation, or required signature is missing or incomplete.
Response not matched
The information was sent, but the payer did not receive it or did not connect it to the correct claim.
Outdated contact details
The payer's request went to an old address, phone number, email address, or portal account.
Missed response deadline
The requested information arrived after the payer's deadline or after the claim was adjusted.

Resolution workflow

How to fix a PR-227 denial

01

Read the full remittance

Review the group code, CARC, RARC, payer message, and claim-level notes. Identify the exact information requested and who the payer expected to respond.

02

Confirm the request history

Check payer portal messages, mailed notices, call notes, and prior submissions. If the information was already sent, verify the date, channel, and confirmation number.

03

Contact the patient with a specific ask

Explain what the payer needs, where the patient should send it, and the deadline. If the payer requires a direct response, provide the correct phone number or portal instructions.

04

Submit the missing information

Follow the payer's required channel and retain proof of submission. The next step may be reprocessing, a corrected claim, or an appeal, depending on payer instructions.

05

Track the claim to final disposition

Document outreach, responses, submission details, payer confirmation, and the next follow-up date. Close the work item only after reprocessing or a final determination.

Before billing the patient

PR is not an automatic statement instruction

The PR group code assigns the adjustment to patient responsibility on the remittance, but it should not be treated as an automatic instruction to send a statement immediately. Review the payer's instructions, your contract, required notices, and applicable billing rules first. In many cases, the cleanest outcome is to help the patient complete the payer's request and ask the payer to reprocess the claim.

Prevention

Prevent repeat PR-227 denials

Prevention depends on catching missing information early and making unresolved payer requests visible.

Verify patient and subscriber information at registration
Confirm current contact information and communication preferences
Include coordination-of-benefits questions in pre-service verification
Monitor payer requests instead of waiting for the next remittance
Route 227 denials by payer, RARC, and missing-information type
Track patient outreach and response deadlines in one work queue
Review recurring patterns by location, payer, and registration workflow

The goal is not to shift blame to patients or front-desk teams. Payer requests, coverage records, and coordination-of-benefits rules change. A reliable process gives staff and patients a clear next action before the claim stalls.

How Ember helps

Turn a denial code into a trackable workflow

Ember analyzes denial signals, including CARC and RARC information, to surface root causes and recurring patterns by payer, code, specialty, and location.

Before submission, Ember can flag denial risk and missing documentation for staff review. When a denial requires an appeal, Ember drafts an evidence-backed letter for human review, assembles the supporting packet, and tracks deadlines and outcomes through the workflow.

Prevent more denials
01

Detect

Read the CARC, RARC, payer, and claim context

02

Route

Assign the patient follow-up and response deadline

03

Resolve

Keep the response, evidence, and human review together

04

Track

Monitor reprocessing, appeal deadlines, and final outcome

Frequently asked questions

Is PR-227 the same as CARC 227?

CARC 227 is the reason code. PR is the Claim Adjustment Group Code for patient responsibility. The full remittance should also include a remark code that helps explain what information is missing.

What information is usually missing with denial code 227?

It varies. The payer may be waiting for coordination-of-benefits information, accident details, subscriber information, a questionnaire, a signature, or another patient-supplied response. Read the RARC and payer message before taking action.

Should a provider appeal PR-227?

Not always. Some payers will reprocess the claim after receiving the missing information. Others may require a corrected claim or formal appeal. Follow the payer's instructions and preserve proof of submission.

Can the balance be billed to the patient?

The PR code indicates patient responsibility on the remittance, but billing still depends on the payer response, provider contract, notice requirements, and applicable rules. Review the claim before sending a statement.

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